Nephro-Urology Monthly
Volume:9 Issue: 1, Jan 2017

There is a new technique to measure total body water named bio-electrical impedance analysis (BIA), used in healthy subjects and patients. BIA determines the total body water (TBW), fat-free mass (FFM), body cell mass (BCM), extra cellular water (ECW), and intra cellular water (ICW) in subjects without significant fluid and electrolyte imbalance. There are several methods such as segmental BIA, multi-frequency BIA, and bio-electrical spectroscopy to perform a BIA. The positive fluid balance has effects on morbidity and mortality in patients with critical illnesses. In such patients, monitoring fluid status and fluid overload is an important issue. The current study aims at discussing parameters of BIA and whether they can control fluid imbalance of patients with critical illnesses admitted in intensive care units..

Higher urinary albumin excretion has been suggested as a predicting diabetic nephropathy..
The present study aimed at determining the prevalence and risk factors associated with albuminuria in patients with Type 2 diabetes mellitus in north of Iran, Rasht..
Two hundred and four patients who referred to a diabetes center in north of Iran were enrolled in the current study. Urinary albumin excretion (UAE) was measured by immunoturbidimetric assay. Microalbuminuria and macroalbuminuria were considered as a UAE rate of 30 to 300 mg /24-h and more than 300 mg/24-h, respectively. Risk factors associated with albuminuria were evaluated by backward stepwise logistic regression..
The prevalence of micro and macroalbuminuria was 17.2% and 17.6%, respectively. Microalbuminuria was significantly associated with longer diabetes duration, increased fasting plasma glucose, and diastolic blood pressure. It was also found that higher plasma glucose and BUN (blood urea nitrogen) were risk factors for macroalbuminuria..
Prevalence of both micro- and macroalbuminuria was high in the patients of this study. Therefore, it seems that controlling blood glucose and lowering blood pressure, even in the absence of hypertension-prehypertension, should be considered for patients with microalbuminuria..

Nephrolithiasis in children is an important cause of morbidity worldwide. The current retrospective study aims at identifying epidemiological characteristics and risk factors of nephrolithiasis among children under 18 years old attending at nephrology clinic of Amir Kabir hospital of Arak, Iran, in 2014..
The current case-control study was conducted among 166 children in 2 equal groups of cases (with nephrolithiasis) and controls (without kidney stone). Clinical and paraclinical characteristics of children along with their sociodemographic and risk factors were collected. Data were analyzed by SPSS version 20 using Chi-square test and logistic regression analysis..
The current study showed that the most common symptoms of pediatric nephrolithiasis included fever (81.1%), urine discoloration (8.4%), pain (6%) and dysuria (3.6%). Urinary tract infection (42.2%) was the most common cause to seek medical care. The present study findings revealed series of predicative factors for nephrolithiasis including father’s occupation, growth retardation, type of nutrition during infancy, weight-for-age percentile, body mass index (BMI), and gestational age..
Findings of the current study, which require further consideration, identified common symptoms of nephrolithiasis in children. Future studies are greatly recommended to investigate risk factors of pediatric nephrolithiasis along with confounders in studies with a larger sample size..

Social, behavioral, and medical factors that predict specific causes of deaths may vary across countries..
Current study aimed to determine social, behavioral, and medical characteristics that predict kidney disease mortality in general population in the United States..
Data came from the Americans’ changing lives study (ACL), a nationally representative cohort, 1986 - 2011. The study followed 3,617 adults over age of 25 for up to 25 years. Main outcome was time to death due to kidney diseases, derived from death certificates and national death index. Cox proportional hazards models were used to determine the associations between baseline demographic (age, gender, and race), social (education, income, employment), behavioral (exercise, drinking, smoking), and medical (hypertension, diabetes, obesity, depression, and self-rated health) factors and renal disease mortality..
In multivariable model, race, age, drinking, smoking, hypertension, and diabetes at baseline predicted deaths due to renal disease. Gender, education, income, employment, exercise, self-rated health, and depression did not predict the outcome..
Baseline characteristics can inform who is at higher risk of renal disease mortality over the next 25 years. Race, age, drinking, smoking, hypertension, and diabetes at baseline can all inform programs to reduce burden of kidney disease..

Immunosuppressive drugs have received the most attention for Idiopathic Membranous Nephropathy (IMN) that include alkylating agents such as tacrolimus and cyclosporine..
This study was aimed to evaluate the efficacy of tacrolimus versus cyclosporine in the treatment of IMN in the Western region of Iran..
This clinical trial and double-blind study was performed on IMN patients based on the primary biopsy with a range of 15 to 70 years. The patients with secondary membranous nephropathy such as hepatitis B, hepatitis C and systemic lupus erythematosus were censored from the study. Group C was treated with cyclosporine 3 - 6 mg/kg/d and a low dose of prednisolone and Group T was treated with tacrolimus 0.05 mg/kg/d and low dose of prednisolone..
68 patients were entered in our study, 34 patients were randomly selected in Group T and 34 patients in Group C. The 24-hour urine protein reduced significantly in the two groups after the 3rd and the 6th month compared with the baseline. Uric acid increased in Group T after 3 and 6 months compared with the baseline (P Cyclosporine and tacrolimus reduce proteinuria and serum creatinine after 6 months. Nonetheless, tacrolimus reduces urea and cyclosporine increases it. However, since the prevalence of the side effects of both drugs is similar, tacrolimus has better results in the treatment of IMN patients compared with cyclosporine..

Abnormal mineral metabolism is common among hemodialysis patients and has been associated with higher morbidity and mortality rates..
A cohort of 532 hemodialysis patients was selected from nine hemodialysis centers in September 2012 and were prospectively followed-up for a median of 28 months. Unadjusted and adjusted (in terms of age, gender, dialysis vintage, body mass index, albumin level, and comorbidities) hazard ratios (HRs) of mortality associated with serum phosphorus, calcium, and parathyroid hormone (PTH) levels were calculated, using Cox proportional hazards model..
In the unadjusted model, HRs of mortality for serum phosphorus While high serum PTH, calcium, and phosphorus levels could determine the mortality risk in hemodialysis patients, decreased serum phosphorus and PTH levels were in association with malnutrition and comorbidities and were not independent risk factors for mortality..

Adequate dialysis improves patients’ outcome. Single pool Kt/V (spKt/V) > 1.4 is recommended as an index of adequacy. In this study, we assessed dialysis adequacy, the etiologies of under dialysis and the solutions..
In a multicenter nationwide cross-sectional study, 7,009 point-prevalent hemodialysis patients were evaluated for dialysis adequacy, blood flow rate (BFR), total body water (V), and the required dialyzer KoA..
The mean age was 57.2 ± 14.9 years. About 90% of the patients were dialyzed 12 hours per week, but only 27.4% had spKt/V > 1.4. The mean BFR was 297.58 ± 28.6 cc/min (4.66 ± 0.84 cc/min/kg). The mean KoA was 787.28 ± 137.19 cc/min. Those with spKt/V > 1.4 had smaller body size and higher BFR. To achieve spKt/V of 1.4, 79.3% of the patients required dialyzer, with KoA of 700 cc/min or more with an average BFR of 400 cc/min. Of the patients, 17.8% had to use either higher BFR (≥ 400 cc/min) and KoA (≥ 1400 cc/min), or be dialyzed for at least four sessions per week, the latter seemed more feasible..
Low BFR and inappropriate dialyzer choice were the leading causes of inadequate dialysis. With respect to attaining the most adequate dialysis based on solute removal, it seems reasonable to evaluate the causes of low BFR and access dysfunction. Better nursing education and decreasing catheter use may help overcome the barriers..

Despite the high rate of prostate cancer, the incidence of penile metastasis originating from prostate cancer is extremely rare, especially in the form of Peyronie’s disease. Moreover, brain metastasis, which is caused by prostate cancer, is not a common phenomenon and occurs mostly in older patients. Herein, we report a case of a middle-aged man with penile and brain metastasis originating from prostate cancer. The patient was presented with signs and symptoms of Peyronie’s disease without a significant increase in prostate specific antigen (PSA). The final pathological result was prostate adenocarcinoma with a Gleason score of 5 5 = 10 and neuroendocrine features..